CASE STUDY 1 - The hidden economic burden of air pollution-related - - PowerPoint PPT Presentation

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CASE STUDY 1 - The hidden economic burden of air pollution-related morbidity

Olivier Chanel Aix-Marseille School of Economics - CNRS, France Research director at French National Center for Scientific Research Email: olivier.chanel@univ-amu.fr IEHIA, Trieste, April 23-27, 2018

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(2) Swiss Tropical and Public Health Institute, Basel, and University of Basel, CH. (3) The French Institute for Public Health / Santé publique France, Saint-Maurice, F. Reference: Chanel O., Perez L., Künzli N., and Medina S. (2016) The hidden economic burden of air pollution-related morbidity: evidence from the Aphekom project, European Journal of Health Economics, 17(9), 1101–15, Available at http://link.springer.com/article/10.1007/s10198-015-0748-z

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MOTIVATIONS

• Studies of health effects from exposure to AP have generally shown that LT

health effects are much more severe than ST ones. BUT

• Although chronic diseases (CD) are the likely contributors to the mortality

impact, the burden of the chronic morbidity attributable to AP is not explicitly evaluated (except chronic bronchitis).

• Numerous studies indicate that AP can contribute to the development of

chronic pathologies (the new onset of the disease).

• Evidence of health effects due to living in proximity to busy roads is growing

fast => Near Road Traffic-related Pollution (NRTP) may capture something better than Background Pollution (BP).

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Traffic proximity and exposure (Beckerman et al. 2008)

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Objectives of this case study Methodology

• Provide a step-by-step economic assessment of AP-related morbidity:
• a “comprehensive air pollution HIA” that integrates effects of CD and acute

diseases (exacerbation).

• a monetary assessment of this comprehensive HIA.

Application Estimate the health impacts and the economic impacts of air pollution with the standard HIA and with the comprehensive HIA for 10 European cities of the Aphekom project.

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OUTLINE 1 Methodology 11 A comprehensive air pollution HIA 12 How to develop a metric of traffic exposure 13 Methodological issues in economic assessment 2 Application 21 Collecting the relevant epidemiological data 22 Collecting the relevant economic data 23 Annual health and economic assessments of the two HIA 3 Concluding remarks

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1 Methodology

11 A comprehensive air pollution HIA

Other factors

POPULATION

Long term exposure to air pollution

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Other factors

POPULATION

A

Chronic disease onsets due to NRTP

B

Chronic disease onsets not due to NRTP Long term exposure to air pollution

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Other factors

POPULATION

A

Chronic disease onsets due to NRTP

B

Chronic disease onsets not due to NRTP

A’

Exacerbations due to BP

B’

Exacerbations due to BP Long term exposure to air pollution Standard HIA

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Other factors

POPULATION

A

Chronic disease onsets due to NRTP

B

Chronic disease onsets not due to NRTP

A’

Exacerbations due to BP

B’

Exacerbations due to BP

A’’

Exacerbations not due BP

B’’

Exacerbations not due to BP Long term exposure to air pollution Standard HIA

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Other factors

POPULATION

A

Chronic disease onsets due to NRTP

B

Chronic disease onsets not due to NRTP

A’

Exacerbations due to BP

B’

Exacerbations due to BP

A’’

Exacerbations not due BP

B’’

Exacerbations not due to BP Long term exposure to air pollution Standard HIA Comprehensive HIA

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QUESTION: Which type

• f data do we need to

develop a metric of traffic exposure?

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12 How to develop a metric of traffic exposure

Data required:

• Population distribution by age and census or building,
• Land use maps,
• Traffic flow maps or road classification maps.

Method: Use of Geographical Information System to compute the distance of each grid point (with associated population) with the nearest road classified as “major road” (>10,000 veh./day).

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13 Methodological issues in economic assessment

We need unit economic values for the relevant CD / exacerbations: Standard HIA Comprehensive HIA Outcomes AP only causes exacerbation

• f existing CD

AP causes onset of CD AND exacerbations Onset CD

• Box A

Exacerbations Boxes A’ + B’ Boxes A’ + B’ + A” The assumption that AP exposure affects the development of CD has two major consequences that require going beyond the standard economic approach:

• the cost of a prevalent CD attributable to AP is required to assess chronic

morbidity effects (box A)

• when valuing exacerbations among CD patients (boxes A’ and A”), we should

account for the fact that this prevalence cost already includes a fraction of the full exacerbation cost.

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Number of exacerbations in CD due to NRTP (A’) Full exacerb. cost STANDARD HIA MONETARY ASSESSMENT Exacerbation costs due to BP Number of exacerbations in CD not due to NRTP (B’)

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Full exacerb. cost Partial exacerb. cost Partial exacerb. cost Exacerbation costs not due to BP Number of exacerbations in CD due to NRTP (A’’) Cost per CD onset Number of CD onsets due to NRTP (A) Exacerbation costs due to BP Cost of CD onsets due to NRTP Number of exacerbations in CD due to NRTP (A’) Number of exacerbations in CD not due to NRTP (B’) OVERALL COMPREHENSIVE HIA MONETARY ASSESSMENT

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2 Application

21 Collecting the relevant epidemiological data 211 The Aphekom project The Aphekom project: “Improving Knowledge and Communication for Decision Making on Air Pollution and Health in Europe”, Cost: €1,470,900 (54% from European Commission), coordination S. Medina (SpF). Over 3 years (2008-2011), the project has combined the efforts of 60 scientists working in 25 cities in 12 countries across Europe to provide new information and tools that enable decision makers to set more effective European, national and local policies.

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QUESTION: Which type

• f data do we need for

the application to the 10 cities?

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212 Computation of the air pollution exposure

Two superimposed scenarios (global burden)

• no one lives near major roads,
• BP is decreased to WHO AQG for PM10/NO2 (annual mean: 20 µg/m3).

Background pollution Exposure to traffic pollution Population (Million hab.) PM10 annual average (µg/m3) NO2 annual average (µg/m3) Fraction of population within 75m Fraction of population within 100m Fraction of population within 150m Barcelona 1.53 33 36 56% 65% 77% Bilbao 0.31 27 29 29% 40% 59% Brussels 1.03 29 38 37% 47% 64% Granada 0.24 34 31 14% 18% 28% Ljubljana 0.27 32 28 23% 32% 47% Rome 2.81 37 61 22% 29% 43% Sevilla 0.70 41 29 20% 26% 38% Stockholm 1.30 17 13 14% 20% 30% Valencia 0.74 46 32 44% 55% 71% Vienna 1.66 25 51 36% 44% 62%

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213 Epidemiologic data

• Two chronic outcomes (new CD onset): Asthma prevalence (0-17) and Coronary

Heart Disease (CHD) prevalence (+65).

• Two acute outcomes (exacerbation): Hospitalizations for asthma (0-17) and for

Acute Myocardial Infarction (AMI) (+65). Summary of the concentration–response functions used in computations

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22 Collecting the relevant economic data

221 Annual average prevalence cost of a CD patient

Boxplots on the literature review on annual morbidity costs related to asthma (€ 2005)

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Boxplots on the literature review on annual morbidity costs related to CHD (€ 2005)

3017 1553 4641 762 700 1494 4700 4112 7789 11444 5844 8168 6918 4602 7979

2 000 4 000 6 000 8 000 10 000 12 000 14 000 COI - Direct (n= 15) COI - Indirect (n= 6) COI - Total (n= 3)

Boxplots showing the 25th and 75th percentile (high and low edge of the box), the median (bold line in the box), the 2.5% and 97.5% percentile (line below and over the box), and the min and max (small circle below and over the box).

Literature review on morbidity costs related to CHD (in ! 2005)

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222 Average cost per exacerbation (COI method) Average lengths of stay, hospitalization costs, work loss, direct and total hospitalization cost per exacerbation (€ 2005)

Average length of stay in days Average cost per day Direct average

• hospital. cost

Average cost of work loss Total average

• hospital. cost

Country

• Asthm. AMI Hosp. all

causes Work loss

• Asthm. AMI Asthm.

AMI

• Asthm. AMI

Austria 5.1 8.4 319 83 1,627 2,680 847 114 2,474 2,794 Belgium 6.5 8.7 351 98 2,282 3,054 1,274 140 3,556 3,194 Italy 4.8 8.2 379 62 1,819 3,108 595 83 2,414 3,191 Slovenia 4 9.9 240 34 960 2,376 272 55 1,232 2,431 Spain 6.5 9 321 55 2,087 2,889 715 81 2,802 2,970 Sweden 6.1 7.8 427 92 2,605 3,331 1,122 118 3,727 3,449

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Summary of the unit economic values (€2005) Chronic diseases Health outcomes Direct costs Indirect costs Intangible costs Total costs Annual average prevalence cost of asthma onset 1,332 90 1,630 3,052 Asthma Average full asthma exacerbation cost Depends on country (see previous table) Average partial asthma exacerbation cost Full exacerbation cost - 0.5 x annual prevalence cost Annual average prevalence cost of CHD 5,153 277 1,557 6,987 CHD Average full AMI exacerbation cost Depends on country (see previous table) Average partial AMI exacerbation cost Full exacerbation cost - 0.215 x annual prevalence cost

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23 Annual health and economic assessments of the two HIA

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Standard HIA Exacerbation cost due to air pollution: € 0.55 million

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Exacerbation cost not due to air pollution: € 8.3 million Standard HIA Exacerbation cost due to air pollution: € 0.55 million

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Prevalence cost of air pollution CD onset: € 362 million Exacerbation cost not due to air pollution: € 8.3 million

Standard HIA Exacerbation cost due to air pollution: € 0.55 million

Comprehensive HIA Overall cost

• f air pollution

exposure: € 370 million

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3 Concluding remarks

Findings

• Pollutants along busy roads could be responsible for a large but preventable

burden of CD and related acute morbidities in (European) urban areas.

• We found considerable larger burden of AP than with the standard HIA.
• Best preventive action is to avoid the exacerbation by avoiding the disease

altogether => focus on the risk factors for onset of CD. Perspectives

• Approach applicable to other diseases associated to air pollution exposure (like

chronic obstructive pulmonary disease, lung cancer).

• May help decision-makers to properly take into consideration the full benefits of

projects concerning agriculture, energy, health, transport, waste, water, etc., where CDs caused and exacerbated by a common factor are involved: environmental (heavy metals, hazardous chemicals) or not (smoking, alcohol consumption, nutrition).